Provider Demographics
NPI:1326301276
Name:FOWLER, KILBREY D
Entity Type:Individual
Prefix:DR
First Name:KILBREY
Middle Name:D
Last Name:FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KILBREY
Other - Middle Name:D
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8524 MORIN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3332
Mailing Address - Country:US
Mailing Address - Phone:423-316-4759
Mailing Address - Fax:423-778-2275
Practice Address - Street 1:8524 MORIN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3332
Practice Address - Country:US
Practice Address - Phone:423-455-8358
Practice Address - Fax:800-470-1905
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000020382251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045978Medicaid